Researchers from the University of Bristol’s BiO division have advanced the treatment for adrenal disease by testing hormone replacement therapy that more closely mirrors the body’s natural cortisol rhythm. The findings, reported in the Journal of Internal Medicine, highlight a potential shift in how clinicians manage conditions like Addison’s disease and congenital adrenal hyperplasia. Cortisol, a hormone central to memory, immune activity, and blood pressure regulation, often runs low in these conditions. When cortisol is deficient, patients commonly experience nausea, persistent fatigue, muscle weakness, dangerously low blood pressure, and mood disturbances. Traditional management relies on daily hydrocortisone, which raises cortisol levels but frequently falls short of restoring a patient’s overall well-being because it cannot mimic the hormone’s natural fluctuations across the day.
In the new trial, twenty adults aged 18 to 64 with adrenal disease received standard hydrocortisone replacement either as tablets or through a pump designed to imitate the body’s natural cortisol variations. This approach aimed to recreate the diurnal pattern of cortisol release, delivering higher levels in the morning and tapering through the day to better align with daily activities and energy needs. The study combined regular clinical dosing with real-time adjustments via the pump to assess both physiological responses and patient-reported outcomes, providing a comprehensive view of how timing and rhythm influence therapy effectiveness.
Results indicated notable improvements. Fatigue decreased by roughly 10 percent, mood elevated, and energy levels rose by about 30 percent, with the most striking gains seen in morning hours when tiredness is most burdensome. Neuroimaging using MRI revealed subtle yet meaningful changes in how the brain processes emotional information, suggesting that aligning cortisol delivery with natural rhythms can positively affect brain function related to mood and stress responses. These promising signals point toward a potential enhancement of quality of life for individuals living with adrenal disorders, though researchers caution that larger and longer studies are needed to confirm safety and full clinical benefit. The work underscores the importance of considering hormonal timing in replacement therapies and invites further investigation into personalized, rhythm-aware treatment strategies for adrenal diseases.